Drug Story – “On Medicine, with Dr. Eric Topol”

Host: Thomas Goetz
Guest: Dr. Eric Topol, Founder & Director, Scripps Research Translational Institute
Release Date: March 10, 2026

Overview

This special episode of Drug Story diverges from the podcast’s usual drug-centered format to feature a conversation with Dr. Eric Topol, a leading cardiologist and scientist, about the promises and disappointments of personalized medicine, the limits of pharmacogenomics in clinical practice, drug safety and accountability (including the Vioxx scandal), public health versus commercial wellness trends, the science of longevity, and how scientific rigor should drive medical progress.

Key Discussion Points & Insights

1. The High Hopes and Unmet Promise of Pharmacogenomics

• Context: The mapping of the human genome twenty years ago generated excitement that individualized, “DNA-matched” treatment would revolutionize medicine.

  • Thomas Goetz sets the scene: “There was so much excitement about personalized medicine...that medicine would be able to treat people based on their specific genetic patterns...This is called pharmacogenomics, and it was supposed to transform medicine and human health.” [00:02]

• Reality Check: Dr. Topol describes how the vision hasn’t been realized in routine care.

  • Eric Topol: “...as it turned out, we only had a very limited cut of the variants in the genome that were linked to the disease of interest for predicting risk. So a lot of miscues were coming out of that.” [02:27]
  • Despite more than 150 drugs now carrying FDA-approved genetic labels, few clinicians use this information due to logistical and systemic barriers.

• Notable Example: Stevens-Johnson syndrome, a potentially fatal drug reaction, could often be prevented by genetic testing, yet this is not standard practice in the U.S., unlike other countries.

  • Topol: “What we do in this country is like Russian roulette. We give the prescription, we don't get the genomics, whereas in many other countries you cannot give the prescription until the genomic data is available.” [03:37]

[Key Segment: Challenges of Clinical Implementation]

• There is scant progress in incorporating pharmacogenomics into everyday care.
  • Goetz: “That list hasn’t changed very much. And it’s certainly...not worked its way into clinical practice.” [06:24]
  • Topol: “We’ve never really embraced the era of pharmacogenomics in this country...It’s inevitable someday because there’s invaluable information there, but we haven’t done it yet, and that’s sad.” [06:58]

2. Why Pharmacogenomics Remains Sidelined

• Technical and Practical Barriers: Turnaround for genetic tests is too slow, the costs are high, and insurance rarely covers such testing – making real-time decision-making impossible.
  • Topol: “You want to start the medicine and you don’t have that information...By the time you get it...It’s just not feasible.” [06:45]
• Research vs. Practice Disconnect: There’s a gap between scientific understanding and clinical action.
  • Topol: “When there’s this compartment or orbit of medical knowledge and then there’s another huge chasm...of medical practice and they don’t connect at all.” [10:28]
• Oncology is a Partial Exception: Cancer medicine uses some genetic matching, but not as systematically as possible. [10:55]
  • Topol: “It’s an exception, but even there it's not used as widely as it should.” [10:56]

3. Vioxx: A Cautionary Tale of Drug Safety & Industry Accountability

• Topol Recounts the Vioxx Controversy: He was among the first to raise the alarm about the painkiller’s cardiovascular risks.

  • Quote: “In 2001...this drug had serious issues with heart attacks and strokes...not being acknowledged by Merck...I said, this could be a public health disaster.” [12:15]
  • It took three years—and sustained pressure—for the drug to be removed from the market.
  • Merck attempted to suppress the warning, including threatening to sue the journal that published Topol’s findings.

• Aftermath and Moral Frustration:

  • Topol: “Since that time, there’s been no accountability by Merck...they should have been indicted. The senior management who knew what was happening, they had emails that showed they knew about the heart attack problem.” [13:41]

4. Drugs in Practice: The Ongoing Evolution of Evidence

• Clinical trials are not enough: Real-world monitoring is crucial for understanding a drug’s true safety profile. [15:14]
  • Goetz: “The clinical trials are not enough. We have to look at what happens to drugs in the real world.”
• Example: Aspirin
  • Despite its long use, recent research shows risks for older adults outweigh benefits unless clear cardiac disease is present.
  • Topol: “Anyone over 70, unless they have bona fide stent, a bypass operation, a heart attack...they shouldn’t be taking [aspirin] because the bleeding risk is higher than the benefit. So we’re always learning. And the problem is...once something is in practice we don't often rethink it.” [15:48]

5. Longevity: Science vs. Hype

• The Rise of Longevity ‘Influencers’ and Commercialization:

  • Goetz: “Everybody’s all abuzz about longevity again...now it’s all about peptides and protocols and supplements and sales I think maybe.” [18:30]
  • Topol: “All these longevity people, supposedly, you know, influencers...they’re selling and that means to me they’re non credible.” [18:37]

• Topol on Remaining a Trusted Scientist:

  • He refuses offers to market supplements, viewing credibility as incompatible with commercial product sales in the “longevity” arena.
  • Topol: “You’ve lost your real credibility as a scientist because you shouldn’t be doing that.” [18:37]
  • Topol: “I can count on one hand the number of people who are active in healthspan extension and promoting this that aren’t in the business of selling and they’re hucksters.” [19:32]

• The Real Science of Longevity:

  • Improvements in diet, exercise, sleep, social connection have strong evidence; these “lifestyle plus” factors should remain foundational.
  • Topol: “The data to support those basic things has gotten so much stronger as I reviewed in Superagers...But that’s not enough because...lots of people do all those things...and they still wind up with cancer or heart disease or Alzheimer's. That's why we need to build on lifestyle.” [20:53]
  • Future promise: using AI, genetic, and biomarker data to customize prevention.

6. Storytelling, Tuberculosis, and Global Health Equity

• Book Talk: Tuberculosis as a Medical Mystery and Social Challenge

  • Goetz mentions his book, “The Remedy,” on the germ theory and TB’s history; notes how John Green’s bestseller addressed TB with a contemporary, narrative-driven focus.
    • Goetz: “His narrative is about a young man he met in Africa...he has a very strong personal relationship to this guy...that becomes really the through line for the book.”
  • The point: With effective cures available, it’s “absurd that anybody in the world should go without that cure.” [24:55]

• Topol reflects: “When anybody writes a book about tuberculosis...in a high income country, you don’t usually see it...become this big.” [25:32]

7. Pharma’s Dual Nature: Innovation and Accountability

• The Host and Guest Agree:
  • Not “anti-Pharma”—major drug advances have saved lives.
    • Topol: “We have some real incredible progress that’s been made by Biopharma. Right. I mean, no question...The shingles vaccine...GLP-1 whole family of drugs...” [27:48]
  • But the system’s flaws allow dangerous drugs to be promoted without sufficient accountability for harm.
    • Topol: “It isn’t right that these companies, like the opioid companies, Purdue Pharma, the Sackler family...makes these decisions that they knowingly hurt people that should not be accepted by our [society].” [25:54]
    • Goetz: “There is a moral line there that I think...unfortunately, it’s not a legal line, it’s a moral line.” [27:48]

Notable Quotes & Memorable Moments

• On the disappointment of genomics’ clinical impact:

  • “We’ve never really embraced the era of pharmacogenomics in this country...It’s inevitable someday because there’s invaluable information there, but we haven’t done it yet, and that’s sad.”
    — Dr. Eric Topol [06:58]

• On dangerous drug reactions:

  • “What we do in this country is like Russian roulette. We give the prescription, we don’t get the genomics, whereas in many other countries you cannot give the prescription until the genomic data is available.”
    — Dr. Eric Topol [03:37]

• On industry pressure during the Vioxx scandal:

  • “They even pressured the editor of JAMA that if she published our paper, they would sue...They also pressured us directly...I wrote op ed...The company needs to be...more in touch with the harm that it could be inducing.”
    — Dr. Eric Topol [13:12]

• On the commercialization of longevity:

  • “All these longevity people, supposedly, you know, influencers...they’re selling and that means to me they’re non credible.”
    — Dr. Eric Topol [18:37]

Timestamps for Key Segments

• [00:02] — Introduction: Human Genome Project’s promise and expectations for personalized medicine.
• [02:18] — Pharmacogenomics: Defining the field and reflecting on progress and challenges.
• [03:37] — Example of preventable drug toxicities (Stevens-Johnson syndrome, warfarin dosing).
• [06:11] — Discussion on the FDA’s pharmacogenomics drug list and clinical adoption barriers.
• [10:28] — Disconnection between research and clinical practice.
• [12:05] — Vioxx story: Drug risks, whistleblowing, and industry suppression.
• [15:48] — Aspirin and the need to continually revisit clinical practices.
• [18:30] — The longevity industry: Science vs. commercial hype.
• [20:53] — What really works for healthy aging: from lifestyle to data-driven interventions.
• [22:26] — Medical book narratives; lessons from the tuberculosis story.
• [25:54] — The ongoing lack of legal accountability for pharmaceutical companies.
• [27:48] — Pharma’s vital role and its system flaws.

Takeaways

• Pharmacogenomics remains largely unfulfilled in clinical medicine due to cost, logistics, and lack of advocacy, despite powerful insights that could prevent harm and increase efficacy.
• Industry influence and lack of accountability can perpetuate harm, as illustrated with Vioxx and opioid scandals; legal frameworks lag behind ethical imperatives.
• True longevity and health benefits rest on rigorously validated lifestyle and preventive practices, not on commercialized “wellness” products.
• Public health lessons and storytelling still matter for global and individual health, as shown by tuberculosis’ historical and contemporary narratives.

For Further Learning

• Dr. Eric Topol’s writings: erictopol.substack.com
• Thomas Goetz’s book, The Remedy, for history enthusiasts interested in medical mysteries and the story of tuberculosis.

End of Summary